Provider Demographics
NPI:1346586195
Name:LAS CRUCES PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:LAS CRUCES PHYSICIAN PRACTICES, LLC
Other - Org Name:NEW MEXICO CARDIAC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-565-1898
Mailing Address - Street 1:1160 MALL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8128
Mailing Address - Country:US
Mailing Address - Phone:575-521-3270
Mailing Address - Fax:575-521-3504
Practice Address - Street 1:1160 MALL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8128
Practice Address - Country:US
Practice Address - Phone:575-521-3270
Practice Address - Fax:575-521-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM900522525Medicare UPIN